Everything that runs on finances needs a robust financial system that runs it efficiently without creating any revenue gaps. The same goes for the healthcare system. Multiple key elements include a strong healthcare system involving healthcare providers, medical staff, treatments, diagnosis, machines and equipment, drugs, insurance companies, and administrative staff. Some essential steps in the medical billing process are there that the healthcare system needs to follow while processing medical bills.
A medical practice requires a comprehensive financial resource that makes sure that the deliverance of the medical services and the reimbursements for these services to the healthcare staff along with the associated practitioners are made timely.
How Important is RCM in Medical Practice?
Medical practices need to flow the routine tasks smoothly while keeping their practice progress in finances. For this, Revenue Cycle Management (RCM) identifies the ways to keep the processes streamlined and to help practitioners, management software is required to systematize the financial key functions such as medical billing, coding, scheduling, claim submission, and payment collections. Administrative staff managing the RCM should be vigilant with the software functions and be precise in detailing patient data as one small error in the patient information or the service codes can affect the revenue flow of the practice and they may have to work all over again to resubmit reimbursement claims that eventually take hours of effort.
People often get health insurance plans that back patients with lingering diseases and financing expensive medical bills gets tough for them. Insurance companies cover the cost of treatment depending on the plans they buy and the disease estimated cost to be covered according to the insurance plan.
Healthcare systems and healthcare practices depend on the reimbursement process for the services they provide to patients. The medical practices and healthcare system withstand an efficient revenue cycle.
People think that getting a visit to the doctor is simple and smooth, but it entails long paperwork and documentation if more than one visit or treatment is required.
How RCM is Connected to Medical Billing?
The accurate paperwork and documentation for an efficient revenue cycle are essential as the reimbursement for the treatment provided by the insurance providers will only be processed if the claims and paperwork have been done efficiently. The documentation should be tracked and processed meticulously that ensue the compensation for medical healthcare providers such as lab technicians, nurses, doctors, healthcare staff, and therapists equally for their services.
Healthcare data that medical documentation requires include;
- The list of medical procedures performed
- The type of diagnosis and diseases
- The list of medical equipment and supplies that were used
Medical coding and billing are the key features of a healthcare system that make sure that patient data and information are tracked properly and that the flow of information among providers and insurance companies bears no barriers. Hospitals and private practices have experienced billers who are professionally skilled in interpreting, reading, recording, and tracking billing information using codes efficiently. Medical billing on the other hand refers to a process where the claims are properly submitted to the insurance companies in order to acquire the payments for healthcare services provided to their plan holders.
Apparently, coding in the health system refers to the process of translating medical data into coding or alphanumeric codes. These codes are used following the guidelines provided by the federal medical regulatory authorities. The medical data for coding include procedures, diagnosis, treatment, medicines, and equipment utilized during the stay or visit of a patient.
Undoubtedly, billing and coding for the medical system is a hefty task and challenging to keep up with. Small and big medical practices encounter a stream of patients on a regular day with a range of diversified diseases visiting for different medical needs. The stream increasingly surged during the Coronavirus era.
To avoid claim rejection, denials, and delays in reimbursement, medical practices and hospitals must integrate billing management software to report error-free coding and smooth revenue cycle progress. Here are some essential steps in the medical billing process that every practice needs to consider while performing medical billing and coding timely.
11 Key Steps in the Medical Billing Process
1. Patient Check-in and Check-out / Registration
The initial billing process begins with the patient’s first visit. Patients’ demographic information and other data such as age, gender, location, phone number, and residential address must be noted at their first medical encounter. In addition, insurance provider and plan information are key to have at this time, to know if they are covered. Insurance information may contain;
- Insurance plan type
- Policy number or ID
- Insurance provider information
2. Insurance Verification for Successful Medical Billing
As a medical biller, one of your most important responsibilities is verifying patient insurance. This process ensures that patients are responsible for only their portion of the bill and that the provider receives proper reimbursement for services rendered.
There are a few things you can do to streamline the insurance verification process and help ensure successful medical billing. First, make sure you have all the necessary information before starting the verification process. This includes the patient’s name, date of birth, insurance ID number, and the name and contact information of the primary care physician. You will also need to know the dates of service and the procedure codes for the services rendered.
Once you have all the necessary information, you can start the verification process. Begin by calling the patient’s insurance company and requesting verification of benefits. Be sure to have the patient’s information and the dates of the provided treatments.
3. Patient-provider Meeting
The patient-provider meeting is an essential part of the medical billing process. It’s an opportunity for providers and patients to discuss the patient’s medical billing situation and come up with a plan to ensure successful billing.
During the meeting, the provider and patient will review the patient’s medical records, discuss the patient’s insurance coverage, and identify any potential billing problems. They will then develop a plan to address any issues and ensure that the patient’s medical bills are paid in a timely manner.
The patient-provider meeting is an important step in the medical billing process, and it’s one that should not be skipped. By taking the time to meet with your provider and discuss your billing situation, you can ensure that your medical bills are paid promptly and efficiently.
4. Medical Transcription
Medical transcription is an important part of the medical billing process. Without accurate transcription of doctors’ notes, it would be difficult to generate accurate bills. Your medical practitioner will listen to patient information and document it correctly for future treatment and follow-up.
Thus, medical transcriptionists play a vital role in the financial success of medical practices, a single error can result in claim denials.
5. Medical Coding
As anyone in the medical field knows, billing and coding are essential for successful medical practices. Without coding, medical billing would be a very difficult and time-consuming task. Coding is used to categorize medical procedures and diagnoses so that they can be accurately billed to insurance companies and patients.
Coding is a critical part of medical billing because it ensures that the correct procedures and diagnoses are being billed. If a practice does not have accurate coding, it may end up billing for the wrong procedures or diagnoses, which can lead to delays in payment and denials from insurance companies.
Inaccurate coding can also lead to higher costs for practices, as they may have to resubmit claims or appeal denials. Therefore, it is essential that medical practices have a system in place for accurate coding. This can be achieved through proper training of staff.
6. Charge Entry
Charge entry is the process of translating the services provided by a healthcare provider into the codes used by insurance companies to reimburse for those services. In order for providers to be reimbursed, they must submit accurate and complete claims with the proper coding.
There are a variety of different codes that can be used to indicate the services provided, and it is important to select the correct codes in order to receive proper reimbursement. In some cases, there may be multiple codes that can be used to describe a service, and the selection of the most appropriate code is key to efficient billing. The claim must include the following information with codes for a complete and accurate reimbursement;
- Patient information
- Medical history
- Place of service
- Treatment provided
- National Provider index number
7. Claim Generation
In order to be successful at medical billing, you need to be able to generate claims quickly and efficiently. This process can be daunting, but with the right tools and processes in place, it can be streamlined and made much simpler. There are a few things you need to keep in mind when generating claims, including:
- ensuring that all the necessary information is included
- using the correct coding
- submitting the claim in a timely manner
Without accurate claims, there would be no way to get reimbursement from insurance companies or patients. Therefore, it is essential that you have a system in place for generating claims. One way is to use a software program that will automatically generate claims for you. Another way is to manually generate claims.
If you decide to use a software program to generate claims, first, you need to make sure that the program you choose is compatible with the software that your insurance companies use. Otherwise, you will not be able to submit the claims. Second, you need to make sure that the program you choose is easy to use.
8. Claims Submission
Claims submission is one of the most important aspects of medical billing. If claims are not submitted correctly, it can result in delays in payment or even denial of the claim. That’s why it’s important to understand the different types of claims and how to submit them correctly.
There are two main types of claims: direct and electronic. Direct claims are submitted by mail or fax, while electronic claims are submitted electronically through a clearinghouse. Each type of claim has its own set of requirements, so it’s important to understand the difference between them.
The claims submission process can be complex, but there are a few things you can do to make it easier. First, make sure you understand the requirements for each type of claim. Second, gather all the necessary documentation before you begin. And third, double-check your work to make sure everything is accurate and can be processed further. With this, you can actually decrease the time you may put into resubmitting claims if they get denied or rejected due to errors or incorrect information.
9. Claim Denial Management
Claim denial management can be a time-consuming and frustrating process, but it is essential to the financial health of your medical practice. By understanding the common causes of denials and taking steps to correct them, you can minimize the impact of denials on your bottom line.
The first step in effectively managing claim denials is to understand why the denial occurred. Common causes of claim denials include:
- Incorrect or missing information
- The service is not covered by the patient’s insurance
- The patient has not met their deductible
- The claim was filed outside of the insurance company’s grace period
Once you have identified the cause of the denial, you can take steps to correct the issue and resubmit the claim. In some cases, you may need to appeal the denial with the insurance company.
10. Accounts Receivables
In medical billing, accounts receivables (AR) refer to the money that a healthcare provider has billed for but has not yet collected from the patient or insurance company. This can be a significant amount of money for a healthcare provider, as it can take months or even years to collect on some bills.
There are a few things that medical billing providers can do to help speed up the collections process, such as sending out multiple reminders or hiring a collection agency. However, ultimately it is up to the patient or insurance company to pay the bill.
If you are a medical billing provider, it is important to keep a close eye on your accounts receivables. This will help you to follow up in a timely manner and ensure that you are being paid for the services you provide.
11. Payment Collection
There are a few basic steps to take in order to ensure payment after medical billing. First and foremost, make sure that all pertinent information is included in the bill. This means that the patient’s name, address, and insurance information should all be accurate and up-to-date.
In conclusion, be sure to follow up with the patient in a timely manner. If you wait too long to collect a payment, the patient may forget that they even owe you money. A polite reminder a few weeks after the bill is sent should suffice.
Finally, if all else fails, you can always hire a medical payments collection agency to help you get the money you’re owed. While this may be a last resort, it is often an effective way to get paid.